Page 1: Initial questions
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Conducted on
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Location
Page 2: Main checklist
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Van Pictures all around
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Personal Protective Equipment (Please Specify) Harness, Safety boots, Safety gloves, Hard hat
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Protection of works/Pedestrians and vehicle
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Is any excavation works being carried out
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All gate guards in place with GDU?
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Safety warning notices in place? (Chapter 8) Footway closes signs Road closed
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Work location(busy road, school, country road) Please specify Road Speed Supermarket/University
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Are you working at heights?
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If Yes Ladder set up tied at the bottom and the top
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Are you working in Manholes?
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If yes site setup pictures required
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Picture before commencing work
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Equipment in good condition? Petrol Generator Cobras GDU Water Pump
